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The Concept of Conscious Sedation
Introduction
Conscious sedation refers to the process of administering a sedative and anesthetic to a patient during a medical procedure in order to help them relax, relieve anxiety, and block pain (Perry, Potter, & Ostendorf, 2015). During the process, the patient is conscious of the happenings, cannot speak, and maintains cardiorespiratory functions. The procedure allows patients to undergo painful medical procedures and recover quickly.
Symptoms of a Patient Needing Conscious Sedation
The symptoms of a patient who is in need of conscious sedation include needle phobia, anxiety, posttraumatic stress, and pronounced gag reflex. Only patients who are in the American Society of Anesthesiologists (ASA) categories I and II can be treated under CS outside hospitals. Anxious patients are usually treated with oral sedation, intravenous techniques, transmucosal sedation, or inhalation sedation (Gooden, Lowrie, & Jackson, 2018).
Patient evaluation is conducted to aid in deciding whether to carry out the procedure on a patient. The evaluation process involves reviewing previous medical records to identify any underlying medical problems such as obstructive sleep apnea, allergies, respiratory diseases, and organ abnormalities (Perry et al., 2015). It also involves a focused physical examination and laboratory testing. A focused physical examination checks for vital signs and the auscultation of organs such as the lungs and the heart (Gooden et al., 2018). The results of these tests determine whether a patient is fit for conscious sedation. In many cases, sedation is done during procedures that do not require general anesthetics such as routine investigations and minor surgeries.
The Primary Effect of Sedation
The primary effect of sedation is the depression of consciousness level based on the degree of sedation, which can be minimal, moderate, or deep. The primary adverse effect is hypotension, which is characterized by the release of histamine (Gooden et al., 2018). In other cases, respiratory suppression can occur, and its effects are intensified by the administration of sedatives. It is important to monitor patients closely for even the simplest procedure because sedation can have adverse effects such as death or neurological disability (Perry et al., 2015). The majority of sedation-related complications emanate from inadequate oxygenation of the patient due to inadequate respiratory function (Gooden et al., 2018).
Close monitoring ensures that inadequate respiratory function is detected early enough for interventions to be initiated. Monitoring enhances patient safety because patients react differently to sedation dosage. Moreover, it prevents other complications that include hypoxemia, respiratory depression, upper airway obstruction, and pulmonary aspiration.
The Effect of Sedation Dose in Patients
The effect of sedation in different patients depends on the dose given. Minimal sedation involves the administration of low dosage. The patient responds to verbal stimulation and ventilatory and cardiovascular functions remain normal. There may be impairment of cognitive functioning and coordination (Perry et al., 2015). Moderate sedation (analgesia) involves the administration of a modest amount of dosage. In this case, the patient is calm, responds purposefully to verbal commands, and becomes drowsy and sleepy. In deep sedation, high doses of sedatives are administered (Perry et al., 2015).
The patient could become unconscious, the ventilatory function might be impaired, spontaneous ventilation may be insufficient, and the patient is not easily aroused except through painful stimulation. The dose administered is dependent on the age, health status, and the type of procedure being performed (Perry et al., 2015). Deep sedation is unsuitable for patients with weakened immune systems such as pregnant women, children, and individuals with chronic illnesses.
References
Gooden, C. K., Lowrie, L. H., & Jackson, B. F. (2018). The pediatric procedural sedation handbook. New York, NY: Oxford University Press.
Perry, A. G., Potter, P. A., & Ostendorf, W. (2015). Nursing interventions & clinical skills (6th ed). New York, NY: Elsevier Health Sciences.
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